Tommaso Araceli

Purpose: The value of gross total resection (GTR) in patients with brain metastases (BM) is controversial. Therefore, we analyzed the circumstances under which GTR is crucial for optimal outcome in a large population of patients with BM treated with surgical resection at our institution. Methods: The analysis included 539 patients. The extent of resection was rated as complete if no residual contrast-enhancing tumor was detectable on the early postoperative magnet-resonance image (MRI); the tumor size was determined by measuring the volume of the contrast-enhancing areas on the presurgical MRI. Outcome included overall survival (OS) and progression-free survival (PFS). Results: GTR was achieved in most patients (82.8%) but was not associated with longer OS and PFS in the entire population (HR: 0.88; p = 0.162 and HR: 0.84; p = 0.319). However, a significant survival benefit of GTR was observed in patients with solitary BM (HR: 0.39; p = 0.0006). Age younger than 65 years (HR: 0.75; p = 0.047), controlled disease status (HR: 0.68; p = 0.033), focal radiotherapy (HR: 0.64, p = 0.044), postsurgical systemic treatment (HR: 0.67; p = 0.038), and no target therapy (HR: 0.75, p = 0.039) were also associated with significant benefit of GTR. Multivariate interaction analysis showed that solitary BM and controlled disease status significantly influenced the impact of GTR in our patient population (p = 0.0001). Conclusion: Achieving GTR is highly relevant in patients with solitary BM status, controlled systemic disease, specific postsurgical systemic treatment options, postsurgical focal radiation strategies, and in the population younger than 65 years of age.

Purpose: The development of brain metastases (BM) can significantly increase the psycho-oncological burden in cancer patients, requiring timely intervention. In addition, this aspect may negatively affect the course of the disease and treatment outcome. However, screening for psycho-oncological burden is often overlooked in clinical routine. Therefore, we analyzed the extent of psycho-oncological distress in a patient population with BM receiving neurosurgical resection and identified clinical characteristics associated with a high need for psycho-oncological intervention.Methods: We prospectively screened 353 patients (169 female, 184 male, mean age 61.9 years) scheduled for microsurgical resection of one or more BM. Psycho-oncological screening was performed on the day of admission using the Hornheider screening instrument (HSI) and the distress thermometer (DT). Screening results were correlated with demographic and clinical data.Results: Most patients (73.1%) completed the screening questionnaire. Patients who failed to complete the questionnaire presented more frequently with metachronous BM (74.7% vs. 25.3%, p=0.009), were significantly older (p=0.0018), and had a significantly lower KPS score (p=0.0002). Based on the threshold values of the questionnaires, 59.3% of the patients showed a significant psycho-oncological burden requiring immediate intervention. Univariate analysis demonstrated that synchronous BM (p=0.034), tumors in eloquent areas (p=0.001), lower KPS (p=0.031), female gender (p=0.009), and presurgical aphasia (p=0.042) were significantly associated with high psycho-oncological burden. Multivariate analysis showed synchronous BM (p=0.045), female gender (p=0.005), and lower KPS (p=0.028) as independent factors associated with high psycho-oncological burden.Conclusion: The majority of patients with BM have a high psycho-oncological burden. Female gender, synchronous BM, and lower KPS are independently associated with a need for psycho-oncological intervention.

(1) Background: Clinical aspects like sex, age, Karnofsky Performance Scale (KPS) and psychosocial distress can affect the health-related quality of life (HR-QoL) and treatment satisfaction of patients with malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas and caregivers. (2) Methods: We prospectively investigated the HR-QoL and patient/caregiver treatment satisfaction in a cross-sectional study with univariable and multiple regression analyses. Questionnaires were applied to investigate the HR-QoL (EORTC QLQ-C30, QLQ-BN20) and treatment satisfaction (EORTC PATSAT-C33). (3) Results: A cohort of 61 patients was investigated. A higher KPS was significantly associated with a better HR-QoL regarding the functional scales of the EORTC QLQ-C30 (p < 0.004) and a lower symptom burden regarding the EORTC QLQ-BN20 (p < 0.001). The patient treatment satisfaction was significantly poorer in the patients older than 60 years in the domain of family involvement (p = 0.010). None of the investigated aspects showed a significant impact on the treatment satisfaction of caregivers. (4) Conclusions: We demonstrated that in patients with IDHwt gliomas, the KPS was the most important predictor for a better HR-QoL in functional domains. Data on the HR-QoL and treatment satisfaction in patients with IDHwt gliomas and their caregivers are rare; therefore, further efforts should be made to improve supportive care in this highly distressed cohort.